Full Name
*
Email
*
Phone
*
How do you plan to promote our services
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How do you plan to promote our services
Instagram
Tiktok
Youtube
Email List
Website/Blog
Community/Group
Word of mouth
Other
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Estimated Monthly Reach
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Estimated Monthly Reach
Under 1000
1000-5000
5,000 - 25,000
25,000+
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Service Experience
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Have you used Osama Care or Osama Shield
Yes I am currently enrolled
No but I'm willing to enroll after approval
No I'm not interested
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